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					                                                                                                                                                                                                                                                 Appendix A

                                                                                                    Gloucestershire Hospitals NHS Foundation Trust

                                                                                                                Financial Savings Plan 2005/06

Description of the area of saving                         Lead Director    *Actual        Estimated Actions                                                                               Timescales             Comments
                                                          & Manager        Saving         Recurring
                                                                            05/06          Saving
                                                                           £'000           £'000
Reduction in Nursing agency spend                         Maggi Lewis           900             400 · Recruit overseas nurses (adaptation 3-6 months)                                     Mid June 05            Overseas Nurses recruited. Use of unfunded beds
                                                                                                    · Monitor weekly vacancies                                                            12/05/05               significantly reduced. Significant initial reduction in use of
                                                                                                    · Agree numbers of bank/cheaper agencies to be booked in advance on a daily basis                            agency in August followed by further reductions and
                                                                                                    hospital/shift which we give a commitment not to cancel                               End of May 05          sustained low usage. Some pressure through the
                                                                                                    · Consider closing unfunded beds – 2b, Hazelton Annexe. Keep Delancey beds open       Week beg 13/0605       predominantly planned use of additional beds in January and
                                                                                                    · Stop Thornbury for any shifts other than specialists and only as last resort for    Continue               February.
                                                                                                    · Authorisation of Thornbury to continue – Nursing Director and Deputies and ensure
                                                                                                    recording of what is sanctioned to compare with slots filled.                         Recording 13 June 05
Reduction in banding payments for medical staff/use of    Sean Elyan            580             600 ·   Re-band all band 3 posts                                                          March 2005             Hospitals at Night implemented. Further foundation
agency locums                                                                                       ·   Agree funded establishment by directorate                                         May 2005               programmes started in August. Action plans being
                                                                                                    ·   Develop action plans by specialty to achieve band 2b/1a for all staff             October 2005           developed, based on current funded establishment
                                                                                                    ·   Develop action plans by specialty to cease use of locums for planned leave        October 2005

Reduction in waiting list payments (pay only)             Steve Peak            800           1,300 ·     Agree capacity plans                                                            April 2005             Agreed actions achieved. Recent expenditure higher due to
                                                                                                    ·     Agree target specialties                                                        April 2005             difficulties in staff recruitment and workload pressures.
                                                                                                    ·     Submit investment proposals                                                     April/May
                                                                                                    ·     Agree job descriptions                                                          April/May
                                                                                                    ·     Advertise and appoint                                                           May-July
Purchase of PCs through capital programme                 Steve Peak            200             200 ·     Write to budget holders                                                         May 2005               Actioned
                                                                                                    ·     Agree process of allocation                                                     May 2005               Actioned
Gynaecology theatres – Equipment purchases removed
from revenue expenditure                                  Tim Tomlinson              42            42 ·   Identify capital purchases made in 2004/05 through revenue budgets              March 2005             Achieved
                                                                                                      ·   Agree with budgetholder and lead nurse actions for 2005/06                      April 2005             Achieved

Procurement savings from the top 20 items in Pathology.   Adrian Bamford             0              0 ·   Identify top 20 items                                                           May 2005               All actions completed but identified items are specific to
                                                                                                      ·   Procurement to assess impact                                                    May 2005               particular machines and no possible improvements have
                                                                                                      ·   Establish focused meetings with users and procurement where necessary           June 2005              been identified.

T&O – rationalisation of trauma consumables               Tim Tomlinson              0             50 ·   Review current spend patterns with procurement.                                 June 2005              Tender specification in progress. PASA framework may
    ·     Blades and drills                                                                           ·   Establish tender specification                                                  Sept 2005              provide financial benefits: This is being reviewed.
    ·     Plates and screws                                                                           ·   Issue tender                                                                    Oct 2005
    ·     Austin Moore #NOF prosthesis

Sutures – Rationalise to one brand                        Tim Tomlinson              0             70 ·   Approach surgeons with proposal                                                 May 2005               Evaluation successfully completed for General Theatres at
                                                                                                      ·   Set up meetings with surgeons                                                   June 2005              CGH with savings from August 05. Evaluation completed in
                                                                                                      ·   Change order pattern                                                            July 2005              Orthopaedics CGH with indications that it was successful.
                                                                                                                                                                                                                 Evaluation to begin in Ophthalmology in the next few weeks

Standardise surgical stapling devices                     Tim Tomlinson              0             30 ·   Gather information on current usage                                             June 2005              TT has discussed standardisation with surgeons. Tender
                                                                                                      ·   Discuss with surgeons and agree level of standardisation                        July 2005              exercise and evaluation in progress due to be completed Mid
                                                                                                                                                                                                                 October. Decisions on degree of rationalisation to be made
                                                                                                                                                                                                                 in November. Proposals to be made to surgeons in January.
                                                                                                                                                                                                                 Detailed financial evaluations now completed, bar a few
                                                                                                                                                                                                                 queries. To be shared with the MSE Board and the
                                                                                                                                                                                                                 surgeons during February and March with the aim of
                                                                                                                                                                                                                 awarding the contract in April.

Cataract lens                                             Tim Tomlinson              0             10 ·   Discuss with surgeons                                                           June 2005              TT has discussed standardisation with surgeons.
                                                                                                                                                                                                                 Expressions of interest currently being sought, intend to go
                                                                                                      ·   Agree a specification                                                           Sept 2005              to mini tender within PASA framework (expect responses
                                                                                                      ·   Place OJEU advert                                                               Oct 2005               from 6 companies). No savings expected in 05/06. 6
                                                                                                                                                                                                                 Companies are being asked to trial lenses - this process will
                                                                                                                                                                                                                 take at least 3 months to complete.

           Efficiency Savings Report - Appendix A
           Main Board March 2006                                                                                                                                                                                                                         Page 1 of 5
                                                                                                                                                                                                                                            Appendix A

                                                                                                            Gloucestershire Hospitals NHS Foundation Trust

                                                                                                                        Financial Savings Plan 2005/06

Description of the area of saving                            Lead Director        *Actual        Estimated Actions                                                                        Timescales       Comments
                                                             & Manager            Saving         Recurring
                                                                                   05/06          Saving
                                                                                  £'000           £'000
Standardise grafts & mesh usage in general surgery           Tim Tomlinson                  0              0 ·    Discuss with Surgeons                                                   June 2005        Expressions of interest currently being sought, intend to go
                                                                                                                                                                                                           to mini tender within PASA framework. Direct savings
                                                                                                                                                                                                           unlikely, although not confirmed at this stage.

Review usage of TENS machines                                Tim Tomlinson                  0              0 ·    Review evidence for usage                                               July 2005        Intention to change practice, with result that Trust will no
                                                                                                                                                                                                           longer purchase TENS machines. However timescale and
                                                                                                                                                                                                           likely savings unclear at present. Further advice suggests
                                                                                                                                                                                                           the change is not clinically acceptable.

Procurement savings – Disposable drapes                      Tim Tomlinson                  0              5 ·                                                                                             Major exercise to change surgeons' preference for last 20
                                                                                                                                                                                                           years. Will not generate savings this year but savings will be
                                                                                                                                                                                                           larger than estimate if successful. Blind trial to be completed
                                                                                                                                                                                                           by the end of March 2006.
Restricted stock and non-stock catalogues                    Tim Tomlinson                  0             25 ·                                                                                             Work in progress to identify most cost effective product for
                                                                                                                                                                                                           each line with expected growth in savings month on month.
                                                                                                                                                                                                           Concern that new Procurement system may not immediately
                                                                                                                                                                                                           resolve all problems, but rationalisation work has begun in
T&O – DVT prophylaxis, market test foot pumps.               Tim Tomlinson                  0             25 ·    Agree a specification with Procurement                                  July 2005        Tender completed and contract awarded. Potential annual
                                                                                                             ·    Issue tender to supply                                                  Sept 2005        savings of £95k starting in February 06. Current year effect
                                                                                                                                                                                                           to be quantified.

Reduce agency spend in other pay areas                       Steve Peak                     0             50 ·    Review previous spend and strip out ODP agency spend                    May 2005         Authorisation process in place and situation closely
                                                                                                             ·    Agree system of authorisation                                           June 2005        monitored. Problems remain in specialist areas eg IT
                                                                                                             ·    Monitor progress                                                        Ongoing

Improve overall control systems for the requisitioning and   Steve Peak                                      ·    Meet with budget-holders                                                March/April      Achieved
purchasing of non-pay                                                                                        ·    Directorates to agree revised budget-holder and authorised signatures   May              Achieved
                                                                                            0              0 ·    Issue budget-holders with rules to augment SFIs                         May              Actioned

Reduction in spend on clinical waste                         Graham                                          · Pilot scheme to evaluate cost/savings of dedicated post                    June-July 2005   The pilot scheme has been concluded and the evaluation of
                                                             Lloyd/Graham Marsh                                                                                                                            this suggests that it would be financially beneficial to invest
                                                                                            0             50 · Roll out if successful                                                     Sept 2005        in better management of waste, including the addition of one
                                                                                                                                                                                                           new post, in order to achieve savings. Job Descriptions have
                                                                                                                                                                                                           been prepared and are currently being graded with a view to
                                                                                                                                                                                                           implementation in 2006/07.

Minor works to be funded via the capital programme           Graham                                          · New approval system to be developed                                        May 2005         Achieved with identified savings being made to revenue
                                                             Lloyd/Graham Marsh                                                                                                                            budgets
                                                                                                             · In House resource to be created                                            June 2005

                                                                                       128             128 · Capital budget to be created                                                 July 2005

Maintenance contracts to be reviewed as they arise and       Graham                                          · Contract Review Group created                                              April 2005       Project Board and Project Team have been operating since
analysed for value for money                                 Lloyd/Graham Marsh                                                                                                                            June 2005.
                                                                                            20            20 · Monthly review throughout the year                                         Ongoing          A system to “keep score” of the financial effect of actions
                                                                                                                                                                                                           following the monthly reviews is being implemented but the
                                                                                                                                                                                                           Project Board are aware of savings that already exceed the
                                                                                                                                                                                                           target sum for the current year.

           Efficiency Savings Report - Appendix A
           Main Board March 2006                                                                                                                                                                                                                   Page 2 of 5
                                                                                                                                                                                                                                          Appendix A

                                                                                                         Gloucestershire Hospitals NHS Foundation Trust

                                                                                                                     Financial Savings Plan 2005/06

Description of the area of saving                         Lead Director        *Actual        Estimated Actions                                                                    Timescales            Comments
                                                          & Manager            Saving         Recurring
                                                                                05/06          Saving
                                                                               £'000           £'000
Centralisation of switchboard                             Graham Lloyd/Pat                                · Alarms infrastructure                                                  June 2005             Centralisation slipped initially due to difficulties surrounding
                                                          Laverye                                                                                                                                        the alarms project and more recently due to staff concerns
                                                                                         0             85 · Centralisation of Operators                                            Aug 2005              regarding new rotas. These issues have now been
                                                                                                                                                                                                         resolved. Savings estimates on a full year basis remain
                                                                                                                                                                                                         robust and phased implementation of the new arrangements
                                                                                                                                                                                                         commences in April 2006

Desktop stationery contract                               Graham Lloyd /                 30            41 · New contract in place Phase 1                                          May 2005              New arrangements at lower cost in place and savings being
                                                          Designated lead in                                                                                                                             achieved. Core items list agreed and this has been
                                                          Support Services               0             10 · Review of approved items Phase 2                                       July 2005             communicated throughout the Trust.

                                                                                         0              0 · Re-useable print cartridges pilot                                      Sept 2005

Photocopying contract and reduction in desktop printers   Graham Lloyd /                 12            17 · New contract in place Phase 1                                          June 2005             New photocopy contract in place with lower copy charges
                                                          Designated lead in                                                                                                                             achieving the identified savings.
                                                          Support Services                                                                                                                               Substantial further savings should accrue from the second
                                                                                                                                                                                                         phase of the project.

                                                                                                                                                                                                         The implementation of Phase 2 is being overseen by the
                                                                                                       tbc · Removal of DTPs Phase 2                                               July-Oct 2005         Photocopying Project Group and progress has already been
                                                                                                                                                                                                         made in some pilot areas
                                                                                                                                                                                                         A temporary Project Manager has been appointed and takes
                                                                                                                                                                                                         up post in April 2006. A roll out programme for the remainder
                                                                                                                                                                                                         of the Trust will then be developed and implemented in the
                                                                                                                                                                                                         first half of 2006/07

Laundry Contract extension                                Graham Lloyd /                                  · Extension of existing contract with:                                                         Contract now extended.
                                                          Designated lead in                                                                                                                             Saving of £312,000 has been achieved from July 2005 until
                                                          Support Services          140             188 · Renegotiated terms until Jan 2007                                        Phase 1 (June 2005)   end of extended contract in March 2007 (figure includes
                                                                                                                                                                                                         freeze on inflationary uplift which would have applied under
                                                                                         0             40 · Full Contract Tender from 2007                                         Phase 2 (Jan 2007)    the old contract provisions). Savings exceed “best case”
                                                                                                          (Est. extra savings)                                                                           estimates.
Postage                                                   Graham Lloyd /                                  · Restriction on 1st class items                                         June 2005             Mail is sent second class unless otherwise agreed by
                                                          Designated lead in                                                                                                                             managers.
                                                          Support Services
                                                                                         0             35 · Review of service with Post office                                     Sept 2005             The three month trial which commenced in January 2006
                                                                                                                                                                                                         had to be abandoned after the first month as the service
                                                                                                                                                                                                         provider was unable to meet their stated standards in
                                                                                                                                                                                                         relation to the delivery of mail.
Registrar pay – Medicine CGH                              Gill Parker                    0              0 · Full year savings 30k when all registrars move to new rota, 1a to 1b   March 2006            All Registrars moved to new rotas from August. Protection
                                                                                                                                                                                                         and Paternity leave will reduce current year effect. Saving
                                                                                                                                                                                                         already included in reduced banding payments scheme
CGH consultants on call                                   Gill Parker                    2              2 · Move to 1 in 15 on call rota                                           March 2006            Consultant appointment in October will enable the change to

           Efficiency Savings Report - Appendix A
           Main Board March 2006                                                                                                                                                                                                                  Page 3 of 5
                                                                                                                                                                                                                                 Appendix A

                                                                                                     Gloucestershire Hospitals NHS Foundation Trust

                                                                                                                     Financial Savings Plan 2005/06

Description of the area of saving                     Lead Director        *Actual        Estimated Actions                                                                        Timescales    Comments
                                                      & Manager            Saving         Recurring
                                                                            05/06          Saving
                                                                           £'000           £'000
Private ambulance contract                            Graham Lloyd /                 0              0 · Contract for private ambulances Currently spending 72k a year on private   Sept 2005     New contract arrangements for private ambulances have
                                                      Designated lead in                              ambulances.                                                                                been implemented. However these are aimed at reducing
                                                      Support Services                                                                                                                           risks highlighted in recent audit report and will not in
                                                                                                                                                                                                 themselves save money.
                                                                                                         ·   A new contract to be negotiated
                                                                                                                                                                                                 A major piece of work is needed to develop a specification
                                                                                                                                                                                                 for the PTS service the Trust requires which can be used for
                                                                                                                                                                                                 negotiating a revised contract with GAS for 2006/07

Stationery                                            Gill Parker                    3              4 ·      Cease ordering stationery for external agency through trust           June 2005     Actioned and savings being achieved

Non stock ward supplies                               Gill Parker /                                      ·   Review of non stock ward ordering                                     Sept 2005     Review under way with Procurement
                                                      Jan Harding /                  0             tbc

PCI day cases/23 hour stay                            Gill Parker / Phil             2              6 ·      Reduce LOS from 2 days to 1 day and then to day case                  Sept 2005     Change to patient pathway being progressed. Savings to be
                                                      Thomas-Hands                                                                                                                               delivered from October

FP10’s                                                Gill Parker / Pam              4              6 ·      One month supply of drugs on FP10’s                                   June 2005     Actioned
Drug changes                                          Gill Parker / Pam              3              6 ·      Change Adcal to Ergocaliferol                                         Aug 2005      Actioned
                                                                                                         ·   Change from 1g suppositories to 2 x 500g

Locum SHO GRH                                         Gill Parker / Tom              0              0 ·      Recruit floating SHO                                                  June 2005     Actioned. Outcome to be reviewed after 3 months. Saving
                                                      Pickett                                                                                                                                    already included in reduced banding payments scheme
Finance Shared Service                                Terry Smith                    25            25 ·      Principle agreed by countywide DoFs.                                  End June 05   Achieved

Procurement Shared Service                            Terry Smith                    10            10 ·      Principle agreed by countywide DoFs.                                  End June 05   Achieved

Hosted Clinical Services                              Terry Smith               240             240 ·        Principle agreed by countywide DoFs.                                  End June 05   Achieved

Service Charge from Cotswold & Vale PCT               Terry Smith               825           1,649 ·        Joint GHT/C&V working group in place since Autumn 04.
                                                                                                    ·        Final costing models to be produced.                                  Mid June 05   Final figures produced mid July 05.
                                                                                                    ·        Transition path to recharging updated figures to be agreed.           End June 05   Both the recurring impact of the revised costings and a
                                                                                                                                                                                                 transitional arrangement for 2005/06 have been agreed with
                                                                                                                                                                                                 C&V PCT.

Staff costs initiative                                Paul Lilley               320           1,031 ·        Specific targets identified for individual Directors                                The confidential session of the September 2005 Board
                                                                                                                                                                                                 meeting received detailed proposals to reduce budgeted
                                                                                                                                                                                                 staffing levels by 51 whole time equivalent posts with a full
                                                                                                                                                                                                 year saving of £1,031,000. The posts comprise 0.9% of the
                                                                                                                                                                                                 total authorised establishment of 5,714. The savings are
                                                                                                                                                                                                 being carefully managed to minimise the impact on patient
                                                                                                                                                                                                 services and to avoid compulsory redundancies. Whilst the
                                                                                                                                                                                                 majority of the posts were vacant some redeployments have
                                                                                                                                                                                                 been needed which in turn has necessitated a selective
                                                                                                                                                                                                 freeze on external recruitment.
                                                                                                                                                                                                 The 51 posts include 27 in management and administration
                                                                                                                                                                                                 and 3 in catering with the balance of 21 posts to be saved in
                                                                                                                                                                                                 nursing and other clinical professions.

             Efficiency Savings Report - Appendix A
             Main Board March 2006                                                                                                                                                                                                      Page 4 of 5
                                                                                                                                                                                                                                         Appendix A

                                                                                                    Gloucestershire Hospitals NHS Foundation Trust

                                                                                                                  Financial Savings Plan 2005/06

Description of the area of saving                     Lead Director       *Actual       Estimated Actions                                                                           Timescales            Comments
                                                      & Manager           Saving        Recurring
                                                                           05/06         Saving
                                                                           £'000          £'000
Closure of Ward 4b, GRH                               Tim Tomlinson             198           474 ·       Approval to close ward                                                    Sept 2005             Agreed at September 2005 Main Board
                                                                                                  ·       Reduce occupancy to 15 beds                                               During October 2005   Some staff were redeployed to new 23 hour stay
                                                                                                      ·   Full closure                                                              1 November 2005       HR/Nursing have redeployed remaining staff

Hydrotherapy pool-improved efficiency/increased       Steve Peak                    0             38 ·    Main Board approval to proposed actions obtained                          October 2005          An update report is to be provided to the Main Board in
income                                                                                               ·    vacant posts confirmed as part of Trust's savings plan                    October 2005          March 2006. Savings in pay costs expected to be £32k in
                                                                                                     ·    discussions with Partnership Trust to agree appropriate contribution to                         2006/7(included above)
                                                                                                      costs                                                                         January 2006          Income generation schemes in 2006/7 include:
                                                                                                      · other income generating ideas to be pursued rigorously                      March 2006              Self help groups (Full Year Income (FYI)£3.6k)
                                                                                                      · energy conservation to be pursued with better use of a cover for the pool   March 2006              C&VPCT Paediatric Service (FYI £1.9k)
                                                                                                                                                                                                            Aquatots (FYI £2.9k)
                                                                                                                                                                                                            Other (FYI £0.7k)

Stoma Care Service                                    Tim Tomlinson                45             tbc ·   Retender partnership agreement for Stoma care service                     February 2006         Contract retendered and final evaluation complete.
                                                                                                                                                                                                          New contract about to be awarded

TOTAL                                                                          4,529         6,912
-    WLIs funded non-recurringly in 2004/05                                     -800        -1,300
-   PCs capitalised in 04/05 (part)                                             -100          -100
-   Reduction in nursing agency spend                                           -900          -400
-   Reduction in medical banding payments/agency                                -580             0
-   Other reductions in overspending                                            -446
Contribution to savings target                                                 1,703         5,112

* Actual saving refers to funding removed from devolved budgets or reduced overspending

             Efficiency Savings Report - Appendix A
             Main Board March 2006                                                                                                                                                                                                              Page 5 of 5

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